Provider Demographics
NPI:1316721749
Name:PEREZ, ALEXIS JORDAN (BSN RN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JORDAN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1058 PAAOLOULU WAY
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3103
Mailing Address - Country:US
Mailing Address - Phone:808-341-9077
Mailing Address - Fax:844-665-9560
Practice Address - Street 1:91-1058 PAAOLOULU WAY
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3103
Practice Address - Country:US
Practice Address - Phone:808-341-9077
Practice Address - Fax:844-665-9560
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI91125163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management